Therapeutic Use:

Indications for ULTRAM:

Management of pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate.

Adult:

Use lowest effective dose for shortest duration. Individualize. ≥17yrs: initially 25mg every morning; increase by 25mg increments every 3 days up to 100mg/day (25mg four times daily). Total daily dose may then be increased, as tolerated, by 50mg every 3 days up to 200mg/day (50mg four times daily). Usual dose: 50–100mg every 4–6 hours as needed; max 400mg/day. Elderly (>75yrs): max 300mg/day. Renal impairment (CrCl <30mL/min): max 100mg every 12 hours. Cirrhosis: max 50mg every 12 hours. Concomitant use or discontinuation of CYP2D6 inhibitors, CYP3A4 inhibitors or inducers: monitor closely and consider dose adjustments (see full labeling). Withdraw gradually by 25–50% every 2–4 days.

Children:

<17yrs: not recommended.

Contraindications:

Children <12yrs. Post-op management in children <18yrs following tonsillectomy and/or adenoidectomy. Significant respiratory depression. Acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment. Known or suspected GI obstruction, including paralytic ileus. During or within 14 days of MAOIs.